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Maternal and Child Health



Maternity Care Research

 

Monitoring in Pregnancy and Childbirth

The Nursing and Midwifery Research Unit (NMRU) is committed to the use of routine databases and specialist registers to explore current trends in health and healthcare and to inform its ongoing research strategy.   For example, we know from the Confidential Enquiry into Maternal and Child Health (CEMACH) UK, that  stillbirths are a major component of perinatal mortality with just over 1 in 200 pregnancies ending in a stillbirth, of which approximately one-third occur at term.  In greater than 50% of cases the cause of death is ‘unexplained’ using the current classification system.  Growth restriction emerges as the single most important component of stillbirth statistics, often occurring in mothers with no obstetric risk.

 

Examples of ongoing research:

  •        Identifying intrauterine growth restriction (IUGR) in a low risk population, including experience and attitudes of midwives and obstetricians - Dr Dale Spence funded by the Research & Development Office for Northern Ireland.

  •         A descriptive epidemiological study focussing on the link between IUGR and stillbirths in Northern Ireland using CEMACH data - Dr Dale Spence, in collaboration with Prof. Jim Dornan (Royal Jubilee Maternity Services) and Dr Angela Bell (CEMACH). 

  •        A prospective audit of Elective Cesearean Section at term Dr Fiona Alderdice, Dr Dale Spence and Mrs Joanne Gluck in collaboration with the NICORE steering group funded by GAIN.

For further information contact: f.a.alderdice@qub.ac.uk or d.spence@qub.ac.uk

 

 

 

Complex Pregnancy

 

Lay perspectives permeate all areas of the Unit’s work and this strand explicitly promotes a deeper engagement with parents experiencing complex pregnancy.  In addition, research developments at the  NMRU have seen the introduction of an exciting new programme of work exploring the role of midwifery in more traditionally medical domains, for example, antenatal screening involving serum tests and ultrasound technology.  The aims of the programme are very much in keeping with the recent recommendations of the RCM: ‘Where obstetric or other medical involvement is necessary, the midwife continues to be responsible for providing holistic support, maximising continuity of carer and promoting normal physiological progress’ (RCM, Position Paper No26 p2).

 

Examples of ongoing research

  •        Pregnancy and HIV - Dr Fiona Alderdice, Dr Maria Lohan, Dr Dale Spence and Carmel Kelly. Funded by School of Nursing and Midwifery, QUB.

  •     Women’s experiences of antenatal screening - Dr Fiona Alderdice and Dr Jenny McNeill, funded by R&D NI. Dr McNeill has gone on to explore the perspective of midwives in relation to the provision of serum screening for Down’s syndrome in NI. The role of the midwife was highlighted as influential and a further programme of work will focus on midwifery care for women with complex pregnancies.

  •         An interactive DVD to increase awareness of reproductive health issues and preconception care in women with Diabetes: Design, Development, Pilot and Evaluation - Dr Valerie Holmes and Dr Fiona Alderdice with Dr David McCance Royal Hospital, Belfast Trust and Dr Roy Harper Ulster Hospital. Funded by Diabetes UK.

 

 

For further project information contact: f.a.alderdice@qub.ac.uk or j.mcneill@qub.ac.uk,

 

Maternal Nutrition and Pregnancy Outcomes

 

Worldwide, there is increasing interest in the relationship between nutritional status and pregnancy outcome, and in the hypothesis that adult disease originates during intra-uterine development. The importance of pre-conceptional nutritional status for all women is highlighted by the reduction in the prevalence of neural tube defects by folic acid, while pre-conception and early pregnancy nutrition advice are particularly important for women with diabetes to reduce the risk of pregnancy complications. Maternal overweight and obesity is associated with adverse pregnancy outcome, including gestational diabetes, pregnancy induced hypertension and pre-eclampsia, large for gestational age (LGA) or macrosomia (>4500 g), caesarean sections and prolonged labour.

 

Examples of ongoing research:

  •         Diabetes and Pre-eclampsia Intervention Trial Study Group - Dr Valerie Holmes is part of this group investigating the role of antioxidant supplementation (Vitamin C and Vitamin E) in the prevention of pre-eclampsia in women with type 1 diabetes. Funded by The Wellcome Trust.

  •        The impact of maternal obesity on maternal and neonatal outcomes - Dr Dale Spence and Dr Valerie Holmes.

  •        A prospective study exploring risk factors associated with fetal macrosomia and women’s experiences of delivery of a large for gestational age infant - Dr Fiona Alderdice, Dr Valerie Holmes and Esther Reid.  DEL funded PhD studentship.

 

 

For further project information contact: v.holmes@qub.ac.uk

 

The Role of Men in Sexual and Reproductive Health and Healthcare

 

The last decade has brought a new public focus on men’s sexual and reproductive health (SRH) and raised a policy debate about why we should care about it and what we can do about it. Among the impetuses behind this debate, has been an increased awareness of men’s roles in important SRH outcomes, in particular crisis pregnancy and sexually transmitted infections (STIs), as well as increasing recognition of the positive effect on women’s experience of pregnancy of having their male partners involved in pregnancy and early-infant care. The research seeks to probe men’s own experiences of sexual health and healthcare as well as their involvement in reproductive decision-making, care during pregnancy and early-infant care. The health services research implications of this research lie in the development of new health service interventions to provide a couple-centred as well as woman-centred approach in sexual health, maternity and neo-natal health services.

 

Examples of ongoing research

  •        Ready to Reproduce? Teenage Men’s Attitudes and Decision-Making in Relation to an Unplanned Pregnancy - Dr Maria Lohan, Dr Sharon Cruise, Dr Peter O’Halloran, Dr Fiona Alderdice, and Dr Abbey Hyde (UCD). Developed in collaboration with Prof. John T. Condon, Department of Psychiatry, and Dr Carolyn Corkindale, Department of Sociology, Flinders University, South Australia. Funded by The Crisis Pregnancy Agency (IRL).  This study also includes the development and evaluation of an interactive audiovisual tool as a cost-effective component of adolescent sexuality and pregnancy prevention programmes.

  •        Fathering high-risk infants: An in-depth study of parenting babies admitted to a neonatal unit and follow-up at home - Dr Maria Lohan, Dr Dale Spence and Dr Jackie Parkes. Funded by QUB School of Nursing and Midwifery and Tiny Life.

  •       Parents’ Approaches to educating their pre-adolescent and adolescent children about sexuality and reproduction - Dr Maria Lohan with Dr Abbey Hyde, Dr Marie Carney, Dr Jonathan Drennan and Dr Michelle Butler (UCD).  Funded by the Crisis Pregnancy Agency (IRL).

 

 

For further project information contact: m.lohan@qub.ac.uk

 

 

 

Child Health Research

 

 

Child Public Health

 

Unit research projects involved in the monitoring and surveillance of health outcomes in the local childhood population are undertaken using standardised methods of epidemiological data collection and analysis primarily in relation to babies requiring neonatal intensive care and those who survive with cerebral palsy.  While small and premature babies have received much attention both in research and the media, approximately half the babies admitted to neonatal intensive care or surviving with cerebral palsy are born of normal birthweight. Cerebral palsy is an ‘umbrella term’ used to describe a range of conditions associated with problems in early brain development that result in subsequent difficulties with posture, co-ordination and unwanted movement.  Despite recent advances in medical technology and the care of premature and sick infants the rate of cerebral palsy in Northern Ireland has remained relatively constant over the last thirty years. 

  •         Neonatal Intensive Care Outcomes, Research and Evaluation (NICORE ). Dr Fiona Alderdice, in collaboration with the NICORE group who manage this regional database, which was set up in 1994 to monitor the care and outcomes of infants in need of neonatal intensive care across Northern Ireland and is funded by the DHSSPSNI.  NICORE’s work has expanded to include NICU in the Republic of Ireland (funded by HRB/NHSR&D) and NICORE contributes to knowledge internationally as a member of the Vermont Oxford Network which collates data from over 500 NICUs from 26 countries to monitor international trends in mortality and morbidity of premature infants.

  •  Northern Ireland Cerebral Palsy Register – a confidential record of every child and young person born with the condition in Northern Ireland since 1977.  Cerebral palsy is the leading cause of motor impairment in childhood for which there is no cure and a condition where most children have a normal life expectancy.  The Register has been compiled with funding from the Department of Health, Social Services & Public Safety and with the involvement of parents, children and professionals across Northern Ireland. Dr Jackie Parkes in collaboration with the NICPR Steering Group.

 

 

Health, Participation and Quality of life

 

Health, participation and quality of life are increasingly considered important outcomes in the management of children with disabilities like cerebral palsy but also have relevance to children with other chronic and life limiting conditions.  A number of studies being undertaken by staff and students in the Research Unit include relevant measures to assess the extent to which children, mainly with different abilities in cerebral palsy, have been able to achieve this.

 

Examples of ongoing research::

 

  • a longitudinal investigation into the functional abilities, health and participation of 4-16 year old children with ambulant forms of cerebral palsy.  Funded by the Northern Ireland Research and Development Office. Drs Claire Kerr & Jackie Parkes (NMRU) in collaboration with Drs Brona McDowell and Aidan Cosgrove (Belfast Health & Social Care Trust).

 

  • a cross-sectional, clinical survey of children and young adults with severe, non-ambulant forms of cerebral palsy investigating their orthopaedic problems, experiences of services, participation and caregiver assistance.  Collette Donnelly, following the award of the Doctoral Fellowship from the Northern Ireland Research and Development Office and is supervised by Dr Jackie Parkes (NMRU) in collaboration with Drs Brona McDowell and Catherine Duffy (Belfast Health & Social Care Trust).

 

  • a cross-sectional survey of 8-12 year old children with cerebral palsy and their families across nine regions of Europe.  It investigated the extent to which environmental factors (physical environment, policy and social attitudes) impacted on the participation and quality of life of children with similar levels of impairment in different European countries. Funded by the EU’s Framework V r Jackie Parkes (NMRU) and Mrs Anne Madden in collaboration with Professor Allan Colver (University of Newcastle) and other international partners.

 

For further project information contact: j.parkes@qub.,ac.uk

 

User experience and family-centred care

 

The provision of family-centred care has long been recognised as a fundamental principle in the provision of quality care to sick or disabled children being cared for in hospital or at home in the community.  However the extent to which this is a reality for families with sick or disabled children has rarely been systematically evaluated in Northern Ireland.

 

Examples of research:

 

  • an in-depth qualitative study of parents’ experiences of paediatric palliative care (in hospital, hospice and at home) but following the death of their child from a life-limiting illness including cancer.   Ms Jayne Price (NMRU) as part of her funded Sandra Ryan PhD Fellowship Award made by the School of Nursing & Midwifery, QUB.

 

  • (Kathleen Deeney, PhD Student) and the LiLac Study (Collette Donnelly, PhD Student) are incorporating measures of family-centred care as part of their research investigation into the experiences of families with a baby in neonatal intensive care and those with a child or young person with cerebral palsy.

 

For further project information contact: j.parkes@qub.ac.uk