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Title: Biomarkers and outcomes of the diabetes and pre-eclampsia intervention trial (DAPIT)
Author: Wotherspoon, Amy Christine
ISNI:       0000 0004 6496 6840
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2017
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Pre-eclampsia is a serious condition that occurs during pregnancy, which can lead to significant maternal and neonatal morbidity and mortality. Women with type 1 diabetes are at high risk of developing pre-eclampsia. The aim of this thesis was to explicate the acceptability of a screening test for pre-eclampsia and to identify potential biomarkers for predicting pre-eclampsia in women with type 1 diabetes. A number of approaches were used. Firstly, a qualitative study, consisting of interviews and questionnaires, was conducted to gain insight into women’s views on the potential introduction of a pre-eclampsia screening test. Secondly, statistical analysis was conducted on the Diabetes and Pre-eclampsia Intervention Trial (DAPIT) cohort to assess the impact that pregnancy intention has on a number of pregnancy outcomes, including pre-eclampsia. Thirdly, a systematic review was conducted to identify biomarkers that may be of benefit to measure in the DAPIT cohort to predict pre-eclampsia. Finally, two biomarkers were measured in the cohort to assess their potential. Qualitative findings indicated that women wanted to know their risk of developing pre-eclampsia and were generally accepting of the introduction of screening test for the disease. There was no significant association between pregnancy intention and risk of pre-eclampsia. However, women with unplanned pregnancies were more likely to have a baby who needed to be admitted to the neonatal intensive care unit, a baby with a birth weight <5th centile, and to have a longer stay in hospital. The systematic review identified no potentially useful biomarkers suitable for measurement in DAPIT. After consulting existing literature, Fatty Acid Binding Protein 4 (FABP4) and vitamin D (25OHD) were identified to be measured. FABP4 was significantly associated with the development of pre-eclampsia when measured in the first and second trimester. FABP4 also demonstrated some promise as a predictor of pre-eclampsia. Vitamin D was not associated with pre-eclampsia, but was associated with a number of other adverse pregnancy outcomes, including neonatal respiratory problems and small for gestational age (SGA). In conclusion, women should be encouraged to plan their pregnancies to minimise the risk of adverse outcomes. While a screening test for pre-eclampsia would be acceptable to women, further research is needed to identify the optimal screening tool for the prediction in women with type 1 diabetes.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available