Timothy Jeffery’s research while affiliated with Western Australia Health and other places

Background: Controversy surrounds the role of fetal cardiotocography (CTG) in the antenatal management of pregnancy complicated with gestational diabetes mellitus (GDM). Aim: The aim was to investigate whether antenatal CTG aids management in pregnancy complicated by GDM. Materials and methods: A prospective audit of 1404 consecutive antenatal CTG in women diagnosed with GDM. Outcomes for all CTG were audited to determine whether CTG altered pregnancy management. Results: In women requiring combination therapy (diet and medication), 43 CTG were required to change management of a pregnancy. In women managed by diet alone with a secondary pregnancy complication, 161 CTG were required to change management. In women managed by diet alone with no secondary pregnancy complication, CTG did not change management. Conclusions: Antenatal CTG is not recommended in women with GDM managed by diet alone with no secondary pregnancy complication. Antenatal CTG is recommended in women with GDM who require combination therapy (diet and medication). The role of CTG in women managed by diet alone with a secondary pregnancy complication should be based upon the nature of the complication.

This mixed-methods study explores factors associated with and levels of engagement of fathers in antenatal care. One hundred expectant fathers were recruited from antenatal clinics and community settings in Western Australia. They completed validated questionnaires. Eighty-three percent of expectant fathers reported a lack of engagement with antenatal care. Factors significantly associated with lack of engagement in multivariate analysis were working more than 40 hours a week and lack of adequate consultation by antenatal care staff. In qualitative analysis, 6 themes emerged in association with a lack of engagement. They were role in decision making, time pressures, the observer effect, lack of knowledge, barriers to attendance, and feeling unprepared or anxious. Care providers should involve fathers in consultations to improve paternal engagement. For more information go to australianfathersstudy.com

Background: There is no published research on the levels of anxiety and depression in expectant Aboriginal fathers. However, higher rates of mental health problems have been reported at other time points in the lifespan. The mental health status of the father impacts upon family health. The study aim was to determine the level of anxiety and depressive symptomatology in expectant Aboriginal fathers. Methods: Observational study of 50 Aboriginal and 50 non-Aboriginal men whose partners were expecting a baby within a metropolitan health service. Institutional ethics approval and consent were obtained. Fathers were recruited from antenatal clinics and community settings. Researchers administered demographic, HADS and SWLS questionnaires. Results: Aboriginal fathers were older, more likely to be locally born, smoke, and be unemployed, and were less likely to live with their partner and have completed 12 years education, (all p<0.003). Aboriginal men reported lower quality of life scores (p<0.0001). There were no significant differences in total HADS score (p=0.81). However, significant differences were observed within domains. In anxiety domain, non-Aboriginal fathers had higher scores (p = 0.0021). In depression domain, Aboriginal fathers had higher scores (p = 0.0039). In multivariate analysis education (p = 0.0007), employment (p = 0.0009) and Aboriginal race (p<0.0001) retained significant association with a positive depression screen (all p<0.0001) Conclusion: Expectant aboriginal fathers report lower quality of life and anxiety symptomatology, but higher depressive symptomatology than non-Aboriginal controls. For more information on the Australian Fathers Study go to: http://australianfathersstudy.com

Background: The event of childbirth presents a tumultuous and stressful time for families. Father’s health outcomes are particularly important in the modern age with their increasing participation in pregnancy and childbirth. However, limited data has explored factors associated with paternal engagement in antenatal care. The aim was to determine the level and associations of engagement by fathers in antenatal care. Methods: Observational study of 100 expectant men who were involved in the larger Australian Fathers Study. The study had institutional ethics committee approval. Fathers were recruited from antenatal clinics and community settings following informed consent. Research staff administered questionnaires. Data were analyzed using Minitab. Results: 83% of expectant fathers reported a lack of engagement with antenatal care. Factors significantly associated with lack of engagement in multivariate analysis were working more than 40 hours a week and lack of adequate consultation by antenatal care staff. In qualitative analysis, themes from engaged fathers were: a valued role in decision-making and staff behaviour. Themes from unengaged fathers were: no role in decision-making, time pressures, the observer effect, lack of knowledge, barriers to attendance, and feeling anxious. Conclusion: The majority of fathers were not engaged with antenatal care. Employment was a barrier to engagement when men worked >40 hours a week. Adequate consultation by clinical staff improved engagement. Men reported barriers accessing antenatal care due to work, lack of time and knowledge. Flexibility in delivering antenatal care may assist in paternal engagement of working fathers. For more information on the Australian Fathers Study go to: http://australianfathersstudy.com

Background: There is limited research on the modern role or attitudes of expectant Aboriginal fathers. Traditionally males played a limited role in all matters relating to birth. The study aim was to determine if modern Aboriginal fathers identified a role in the antenatal period. Methods: Observational study of 50 Aboriginal men whose partners were expecting a baby within a metropolitan health service. Institutional ethics approval and consent were obtained. Fathers were recruited from antenatal clinics and community settings. Researchers administered demographic, attitudinal and qualitative questionnaires. Results: Aboriginal fathers had a strong preference for natural birth (98%) without surgical or analgesic intervention (84%). 88% and 80% of fathers expressed a positive attitude towards infant vaccination and Down Syndrome screening. Aboriginal fathers were less likely to identify a role in other maternity related decisions. Only 14% identified a role in decisions on baby equipment, 0% on clothing, 0% on disposable/cloth nappies, 16% on breastfeeding, and 2% on creating a birth plan. Only 6% identified a role in promoting healthy lifestyle and diet in pregnancy. However, 90% of men identified a role in creating a safe home environment. Conclusion: Aboriginal men have a strong preference for natural birth and positive attitudes towards vaccination and screening, but few identify a role in other pregnancy decision-making processes apart from a responsibility to provide a safe home environment. For more information on the Australian Fathers Study go to: http://australianfathersstudy.com