Lucy Mackillop

• BM BCh MA FRCP Edin
• Consultant at Oxford University Hospitals NHS Trust

Objective: To determine the accuracy of self-testing for proteinuria during pregnancy. Design: Diagnostic accuracy study. Setting: Antenatal clinics, maternity assessment units, and inpatient wards at three hospital sites. Population or sample: 345 pregnant women. Methods: Pregnant women self-tested in-clinic for urinary protein using visu...

Background Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the devel...

Objective This study aimed to understand the views and practice of obstetricians regarding self-monitoring for hypertensive disorders of pregnancy (blood pressure (BP) and proteinuria), the potential for self-management (including actions taken on self-monitored parameters) and to understand the impact of the COVID-19 pandemic on such views. Design...

The ratio of maternal serum sFlt-1 (soluble fms-like tyrosine kinase 1) to PlGF (placental growth factor) has been used retrospectively to rule out the occurrence of preeclampsia, a pregnancy hypertensive disorder, within 7 days in women presenting with clinical suspicion of preeclampsia. A prospective, interventional, parallel-group, randomized cl...

Objective: Pregnancies in women with Loeys Dietz Syndrome (LDS) are rare, and typically documented in case reports only. Early reports suggested high rates of maternal complications during pregnancy and the puerperium, including aortic dissection and uterine rupture, but information on fetal outcomes was very limited. Design: A retrospective coh...

Thyroid dysfunction affects approximately 3% of pregnant women. Adequate thyroid hormone levels are important for fetal development. Normal physiological changes of pregnancy can contribute to subclinical hypothyroidism which may require treatment with thyroxine during pregnancy. Pre-existing hypothyroidism requires an increase in thyroxine dosage....

Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Aim: To compare diabetes associated maternal and neo...

Aim Little evidence guides the optimal monitoring and management of blood glucose (BG) in women with gestational diabetes mellitus (GDM). Guidelines are based on population-based thresholds and care is not tailored to the needs of the mother and her baby. We aim to explore the utility of data analytics for identifying novel outcome predictors in wo...

Introduction Surveillance data from Confidential Enquiries shows that women who become pregnant with pre-existing health conditions are at risk of poor outcomes, and those that have multiple medical problems are at greatest risk. Our understanding of the socio-demographic characteristics, associated medical and obstetric morbidity and pregnancy out...

Background Pregnancies in Marfan’s syndrome(MFS) have higher rates of maternal and neonatal complications. However, there are few large studies to evaluate these complications. Method Retrospective cohort study of women with MFS managed between 1st January 1998 and 1st March 2018, from 11 UK centres providing care for women with cardiac disease. D...

Introduction Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure might improve the detection and management of hypertensive disorders of pregnancy but few data are available, including regarding appropriate thresholds. Objective Thi...

Introduction Hypertension affects around 10% pregnancies and is associated with adverse maternal and fetal outcomes. Clinic blood pressure (BP) is typically used to monitor and titrate antihypertensive medication during pregnancy. In the general adult population, antihypertensive titration using self-monitoring improves BP control. This study aimed...

Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure (BP) might improve the detection and management of hypertensive disorders of pregnancy, but few data are available, including regarding appropriate thresholds. This systematic revie...

Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postna...

Background: Treatment of hyperglycemia in women with gestational diabetes mellitus (GDM) is associated with improved maternal and neonatal outcomes and requires intensive clinical input. This is currently achieved by hospital clinic attendance every 2 to 4 weeks with limited opportunity for intervention between these visits. Objective: We conduc...

Appendix S1 Biomarker assays. Table S1 List of biomarker abbreviations and units Table S2 Biomarker assay information Table S3 Results of factor analysis: loadings of biomarkers on five largest factors (eigenvalues > 2) after varimax rotation showing loadings > 0.6 only and uniqueness > 0.6 Table S4 Odds ratios derived from multiple logistic re...

Background Inflammatory bowel disease (IBD) commonly affects women during their childbearing years. Published data suggest that observed low fertility rates in IBD are due to voluntary childlessness and quiescent IBD does not confer decreased fertility. Active IBD at conception is reportedly associated with higher rates of preterm birth, low birth...

Background Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia. Methods This prospective cohort study of self-monitoring BP in pregnancy...

Background Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidity worldwide. Raised blood pressure (BP) affects 10% of pregnancies worldwide, of which almost half develop pre-eclampsia. The proportion of pregnant women who have risk factors for pre-eclampsia (such as pre-existing hypertension, obesity and advanced m...

Objective: To investigate feasibility and acceptability of self-testing for proteinuria during pregnancy. Study design: Mixed methods approach which included: an accuracy study where pregnant women (n = 100) and healthcare professionals (n = 96) tested seven synthetic protein samples and completed a questionnaire, a feasibility study where pregn...

Objectives Hypertensive disorders of pregnancy (HDP) affect one in ten pregnancies and often persist postpartum when complications can occur. We aimed to determine the effectiveness and safety of pharmacological interventions, other interventions and different care models for postpartum hypertension management. Design A systematic review was under...

Introduction Successive confidential enquiries into maternal deaths in the UK have identified an urgent need to develop a national early warning score (EWS) specifically for pregnant or recently pregnant women to aid more timely recognition, referral and treatment of women who are developing life-threatening complications in pregnancy or the puerpe...

Key content Epilepsy is the most common serious neurological problem encountered in pregnancy; however, women with epilepsy are often not referred to high‐risk pregnancy services. The 2015 Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK ( MBRRACE‐UK ) report on maternal mortality highlights that the care of...

Question We performed an initial evaluation of a novel self-management intervention for the titration of antihypertensive therapy by hypertensive women following delivery aiming to assess both feasibility and effect on blood pressure. Methods Postnatal women, with gestational hypertension or pre-eclampsia requiring antihypertensive treatment, were...

Aim: To determine the utilisation of computed tomography pulmonary angiography (CTPA) and lung scintigraphy in the UK, and to assess their diagnostic qualities in the investigation of suspected pulmonary embolism (PE) in pregnancy. Materials and methods: Data were collected via electronic questionnaire in the UK from 24 sites. Data on the choice...

Objective: To evaluate the test performance of 47 biomarkers and ultrasound parameters to predict subsequent delivery of an SGA infant and adverse perinatal outcome in women presenting with suspected preeclampsia. Methods: In a prospective, multicentre observational study, 47 biomarkers and ultrasound parameters were measured in 397 women presen...

Breathlessness in pregnancy is a very common symptom. We discuss in this review, the physiological changes to the respiratory system in pregnancy and the commonly seen respiratory ailments like asthma, pneumonia and tuberculosis. Treatments for most conditions are similar to those administered to non-pregnant women. However, conditions may sometime...

Background Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy. Objective To perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether...

Objective To model the resource implications of placental growth factor (PlGF) testing in women with suspected pre-eclampsia prior to 35 weeks’ gestation as part of a management algorithm, compared with current practice. Methods Data on resource use from 132 women with suspected pre-eclampsia prior to 35 weeks’ gestation, enrolled in a prospective...

CHEERS Checklist. (DOC)

Aims: Turner’s syndrome (TS) is associated with bicuspid aortic valve (BAV), ascending aortic dilatation (AD), aortic coarctation, and hypertension. Pregnancy in TS is associated with increased risk of aortic dissection (2%), gestational hypertension, pre-eclampsia and a 2% risk of maternal mortality. This retrospective study aimed to assess the ef...

Aims: Oocyte donation (OD) is increasingly utilised in women with Turner’s syndrome (TS). However, guidelines state TS a ‘relative contraindication’ for pregnancy, due to increased risk of aortic dissection (AD 2%) and maternal mortality (2%). Recent data on OD-related morbidity and mortality in TS has raised further concern. We aimed to analyse ca...

The syndrome of haemolysis, elevated liver enzymes and low platelets is a rare condition specific to pregnancy, affecting approximately 5–20% of all pre-eclamptic pregnancies. Described here is a woman in her first pregnancy, who experienced an intrauterine death following a significant hepatic haematoma and capsular rupture, in the absence of clas...

The physiological and haemodynamic changes that occur in pregnancy and the postpartum period increase the risk of aortic dissection. Loeys-Dietz syndrome results from mutations in the genes encoding components of the TGF-β signalling pathway; aortic pathology is of particular concern in this condition but other vascular abnormalities can also be pr...

Hypertensive disorders of pregnancy affect approximately one in ten pregnancies and often persist postpartum. Their postnatal course can be unpredictable and complications may occur, hence control remains important but is informed by little evidence. Clinicians from UK primary and secondary healthcare were invited to complete a survey regarding ant...

Objective: To evaluate 47 biomarkers (selected from the current medical literature), in isolation or in combination with placental growth factor (PlGF), to determine the need for delivery within 14 days, in women presenting with suspected preterm preeclampsia. Methods: In a prospective, multicenter observational study, 47 biomarkers were measure...

Aims: Women with Turner’s syndrome (TS) are increasingly undertaking pregnancies, either via natural conception (mosaic TS) or assisted conception (AC). Increased TS pregnancies have led to reports suggesting high risk of pregnancy associated aortic dissection (AOD) 2%, and maternal mortality 2% due to underlying aortic valve abnormalities and aort...

Introduction The prevalence of gestational diabetes mellitus (GDM) is rising in the UK. Good glycaemic control improves maternal and neonatal outcomes. Frequent clinical review of patients with GDM by healthcare professionals is required owing to the rapidly changing physiology of pregnancy and its unpredictable course. Novel technologies that allo...

Vaccinations are a cost-effective means of preventing disease. They may be recommended in pregnancy for maternal benefit or for prevention of intrauterine infection of the fetus. Increasingly, it is recognised that vaccination in pregnancy can provide protection through passive immunity for the newborn infant. The MBRRACE-UK 2014 report demonstrate...

Introduction Vital signs (blood pressure, heart rate, temperature, oxygen saturation and respiratory rate) are thought to undergo changes during and immediately after pregnancy. However, these physiological changes are not taken into account in the normal ranges, which themselves are not evidence-based, used in routine and acute care monitoring. We...

Key content The authors discuss commencing biologics in pregnancy and the potential side effects. Infection is a particular risk, which may be atypical or present atypically. While there is no evidence of teratogenicity, these drugs cross the placenta and neonatal cord drug levels may exceed those of maternal drug levels. If possible, anti‐tumour n...

Pregnancy is an insulin resistant state. Hyperglycaemia and gestational diabetes mellitus are well-recognised complications even in women without existing metabolic syndrome or obesity. Pregnant women also appear to be more vulnerable to ketoacidosis, particularly after short periods of reduced oral intake in the third trimester, and may present wi...

Introduction: Pre-eclampsia (raised blood pressure and proteinuria) complicates 2% to 8% of pregnancies, and increases morbidity and mortality in the mother and child. Pre-eclampsia is more common in older women, women with a high body mass index, and women with multiple pregnancy. Pre-eclampsia risk is also increased in women with underlying medi...

Many pregnant women gain excess weight during pregnancy which increases the health risks to the mother and her baby. Interventions to prevent excess weight gain need to be given to the whole population to prevent excess weight gain. The aim of this study was to assess the effectiveness of a simple and brief intervention embedded withinroutine anten...

Non-diabetic ketoacidosis is increasingly recognised in pregnancy, particularly during the third trimester, and is usually associated with vomiting. In many cases, the cause of the vomiting is not identified and resolves rapidly, alongside the metabolic abnormalities, following delivery. Here, we report three cases in which pancreatitis was identif...

Assessing blood glucose (BG) control in women with gestational diabetes mellitus is challenging, as routine tests, for example HbA1c assessment, are an insensitive measure of response to the progressive changes of glucose regulation in pregnancy [1,2]. Consequently, the standard of care remains visual inspection of BG paper diaries of self-performe...

Objectives: To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis–fundus height (SFH). Methods: This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and...

Objectives Cardiopulmonary exercise testing (CPET) is a well-established investigation used to stratify operative and anaesthetic risk as well as being predictive of cardiovascular morbidity and mortality. Pregnancy is a biological stress test and we hypothesised that CPET could risk stratify women with cardio-respiratory or metabolic disease durin...

To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis-fundal height (SFH). Multicentre, prospective observational study recruiting 601 women with singleton pregnancies and reduced SFH between 24-37 weeks...

Background Cystic fibrosis manifests as a multisystem disease, despite this female fertility is relatively preserved with levels approaching that of the non-cystic fibrosis population. We reviewed pregnancies in cystic fibrosis patients over a 10-year period from a UK adult cystic fibrosis centre by considering maternal and fetal outcomes. Methods...

The goal of managing classical Hodgkin lymphoma (cHL) in pregnancy is to obtain good long-term outcomes for both the mother and fetus. Given the excellent outcomes outside of pregnancy, the goal of treatment should remain curative. There remains a tension and debate regarding the timing of chemotherapy, the curative nature of such treatment and the...

An increasing number of women with complex cardiac disease are becoming pregnant which brings challenges for cardiologists, obstetricians and anaesthetists. Assessing risk and counselling patients prior to pregnancy is important; however, often women have unplanned pregnancies, or their cardiac condition is not diagnosed until during pregnancy. Nor...

Venous thromboembolism is a significant cause of maternal death in the UK, despite being a preventable condition for which clear risk factors have been identified. The introduction of routine antenatal and postnatal thromboprophylaxis for women identified by risk assessment tools has been linked to a steady reduction in the number of deaths. This c...

Guidelines encourage the use of self monitoring of blood pressure in pregnancy, and research suggests that women prefer it. But Hodgkinson and colleagues explain that our enthusiasm may run ahead of the evidence and call for more research before it is routinely adopted Self monitoring of blood pressure is increasingly popular with patients and heal...

Background The increase in gestational diabetes mellitus (GDM) is challenging maternity services. We have developed an interactive, smartphone-based, remote blood glucose (BG) monitoring system, GDm-health. Aims The objective was to determine women’s satisfaction with using the GDm-health system and their attitudes toward their diabetes care. Met...

Background Gestational diabetes mellitus (GDM) is defined as new onset or recognition of glucose intolerance in pregnancy. Evidence supports tight blood glucose regulation to prevent adverse maternal and fetal outcomes. Finger-prick blood glucose (BG) testing with frequent clinic review remains the most common method of managing diabetes in pregnan...

Hypertensive disorders of pregnancy are a major contributor to death and disability for pregnant women and their infants. The diagnosis of preeclampsia by using blood pressure and proteinuria is of limited use because they are tertiary, downstream features of the disease. Placental growth factor (PlGF) is an angiogenic factor, a secondary marker of...

Free-text comments in multi-source feedback are intended to facilitate change in the assessee's practice. This study was designed to utilise a large dataset of free-text comments obtained in a national pilot study in order to investigate how helpful these free-text comments may be to assessees. We investigated: (i) which areas of performance are us...

Background Cystic fibrosis manifests as a multisystem disease, despite this female fertility is relatively preserved with levels approaching that of the non-cystic fibrosis population. We reviewed pregnancies in cystic fibrosis patients over a 10-year period from a UK adult cystic fibrosis centre by considering maternal and fetal outcomes. Methods...

Neurological diseases are a major cause of morbidity and mortality in pregnancy. The management of multiple sclerosis, epilepsy, myasthenia gravis, certain neuropathies and headache in pregnancy is described; the potentially life-threatening conditions of stroke and eclampsia are also discussed. Management of most neurological conditions is similar...

Vaccinations in pregnancy are known to be cost-effective means of preventing disease. They may be recommended primarily for maternal benefit or for the prevention of intrauterine infection of the fetus. Increasingly they are a recognized technique of providing protection to the newborn through passive immunity and by reducing disease exposure.Theor...

Ornithine transcarbamylase (OTC) deficiency is the most common inborn error in the metabolism of the urea cycle with an incidence of 1 in 14 000 live births. Pregnancy can trigger potentially fatal hyperammonemic crises. We report a successful pregnancy in a 29-year-old primiparous patient with a known diagnosis of OTC deficiency since infancy. Hyp...

Cardiac disease is the leading cause of maternal mortality in the UK. The major causes of cardiac deaths in pregnancy include cardiomyopathy, myocardial infarction, ischaemic heart disease and dissection of the thoracic aorta. With increasing numbers of migrant women in the UK, rheumatic heart disease in pregnancy has also re-emerged. Women with un...

Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregna...

Risk of hypertension in mother and offspring after preeclampsia is greater if preeclampsia develops early in pregnancy. We investigated whether those who develop early onset disease have unique adverse blood pressure characteristics. One hundred forty women were studied 6 to 13 years either after a pregnancy complicated by preeclampsia (45 women wi...

Background: There is concern over ionizing radiation exposure in women who are pregnant or of child-bearing age. Due to the increasing prevalence of congenital and acquired heart disease, the number of women who require cardiac interventions during pregnancy has increased. We have developed protocols for cardiac interventions in pregnant women and...

Our aim was to directly assess the postnatal mobility of mothers and to relate and compare venous thromboembolism (VTE) risk with current guidelines on VTE thromboprophylaxis postpartum. VTE still remains one of the leading causes of direct maternal deaths in the western world and this risk is greatest in the postnatal period. Mode of delivery and...

Introduction Pre-eclampsia (PET) contributes significantly to maternal morbidity and mortality. Aspirin prescription is recommended to reduce the incidence of PET. Aspirin treatment for PET prevention was audited against NICE guidelines. Prescriber knowledge was explored to identify whether this was a factor in poor compliance with NICE guidance. M...

Introduction Pituitary apoplexy is a clinical syndrome of selective or multi-hormonal pituitary failure, classically described as a result of infarction of a pre-existing pituitary adenoma associated with pituitary or peri-pituitary haemorrhage. Previous reports in pregnancy have described pituitary apoplexy complicating macroprolactinomas, growth-...

Most deaths are now caused by preventable or treatable medical conditionsSince the first report of the Confidential Enquiry into Maternal Deaths in 1952, the maternal death rate in the United Kingdom has decreased dramatically.1 This has been due to an impressive fall in deaths with direct obstetric causes, including obstetric haemorrhage, ectopic...

Multi-source feedback (MSF) provides a window into complex areas of performance in real workplace settings. However, because MSF elicits subjective judgements, many respondents are needed to achieve a reliable assessment. Optimising the consistency with which questions are interpreted will help reliability. We compared two parallel forms of an MSF...

Introduction As recommended by the National Collaborating Centre for Women's and Children's Health, our protocol screens for anaemia in pregnancy at booking and at 30 weeks. Iron supplementation is offered if Hb ≤11 g/100 ml or mean cell volume (MCV) <82 fl. If Hb ≥11 g/100 ml, ferritin is measured and iron supplementation is offered if ferritin ≤...

Prescribing in pregnancy often causes uncertainty and anxiety for the clinician and may lead to the omission of necessary treatment. Many drugs have inadequate data to assure safety, and therefore the clinician is left with a dilemma as to where the balance of risks and benefits lie with respect to the mother and her fetus. Understanding under what...

The UK Department of Health is considering a single, generic multi-source feedback (MSF) questionnaire to inform revalidation. Evaluation of an implementation pilot, reporting: response rates, assessor mix, question redundancy and participants' perceptions. Reliability was estimated using Generalisability theory. A total of 12,540 responses were re...

Objectives The authors aim to directly assess the mobility of Mothers following delivery and subsequently aim to relate and compare venous thromboembolism (VTE) risk with current guidelines on VTE thromboprophylaxis post partum.BackgroundVTE still remains the leading cause of direct maternal deaths in the western world and this risk is greatest in...

Inflammatory bowel diseases (IBD) typically affect patients in their reproductive years. It has been shown that reproductive issues are of key concern to IBD patients,1 especially women.2 In this respect, it is important to note that IBD patients remain voluntary childless more frequently than non-IBD controls.1,3,4 A recent study reported that IBD...

Our series Prescribing in pregnancy provides guidance on what information to offer pregnant women about the risks and benefits of drug treatment. Here the authors discuss the course of asthma during pregnancy and the use and safety of asthma medications. Copyright © 2010 Wiley Interface Ltd

The presence of abnormal liver function is common in pregnancy. It can be a challenge to elucidate the cause. The history and clinical assessment provide useful tools for distinguishing between pregnancy-related causes, such as pre-eclampsia, acute fatty liver of pregnancy and obstetric cholestasis, and non pregnancy-related causes such as non-alco...